MediServ Surgical Week in Partnership with Access Health Africa

Next month, a team from Access Health Africa, our partner organization operating in Malawi is sending a medical team to Malawi for a week to work with our partners at Kabudula Community Hospital to perform surgeries, dental procedures and train medical professionals there and at rural health centers. Our Global Health Fellows have been working very hard to make this trip a success.

Over 200 patients have been identified throughout the Kabudula catchment area as needing surgery. 100 have been put on the schedule and the GHFs are working to make sure that all patients will be seen if not by the visiting team, then by the Kab staff with help from in-country partners after the trip. We are looking forward to a successful exchange of skills and knowledge.

We have decided to focus our Essential Medicine Delivery program for May and June on supporting this trip through donation of dental and surgical anesthetics.

Head over to the Access Health Africa blog to read more about the trip preparations and updates during the trip!

Meet Watsi Patient Mwaiwawo

Earlier this month, we met Mwaiwawo at Nkhoma Hospital where are run our Watsi partnership program. Mwaiwawo was there to receive a hysterectomy.

Mwaiwawo, Watsi patient at Nkhoma Hospital.

Mwaiwawo, Watsi patient at Nkhoma Hospital.

Mwaiwawo is a single mother of three. She is a cook and a farmer. She has been experiencing abdominal pain and abnormal bleeding due to uterine fibroids since November 2018. She was in need of a hysterectomy to get rid of this problem. She has since been to 4 different hospitals in Malawi to try and have this procedure done. She also previously went to Nkhoma Hospital but could not afford the surgery there at that time.

After she realized that she could not afford the surgery on her own, she turned to her community members to help raise the funds. She also started to pick up side jobs to save money. She still came up short.

Her most recent visit to Nkhoma Hospital, Mwaiwawo was introduced and accepted as one of our Watsi patients, meaning her surgery was fully funded! She has a successful surgery earlier this month and is recovering well. She says “After meeting with my community and trying to do extra piece work also, I was still unable to afford the surgery I need. I am so grateful for this program to assist me!”

We are happy to partner with Watsi to provide funding for these surgeries to be done at Nkhoma Hospital. Mwaiwawo’s story is not uncommon. Almost all patients that we meet have gone to numerous clinics and hospitals seeking help and for various reasons (transportation, funding, staff shortages/training) are unable to receive the treatment they need until they are accepted to this program. Nkhoma Hospital provides patients with top of the line care and we are happy to work with them!

Essential Medicine Delivery

In 2010, WAM visited Kabudula Hospital to find that they were out of just about every useful medicine, including acetaminophen (Tylenol) and diazepam (seizure medication). WAM Vice President Dr. Kevin Bergman recalls children with 104° fever were being sponged down by nurses because that’s all they could do, he also witnessed children with cerebral malaria who had uncontrollable seizures. Kevin says “Parents and healthcare staff were so frustrated and saddened and felt powerless. It was a horrible situation, and that day we knew that we had to help Kabudula.”

Out of this visit, WAM’s Essential Medication Delivery program was developed.

The cold storage pharmacy at Kabudula Hospital

The cold storage pharmacy at Kabudula Hospital

Our Global Health Fellows have been working closely with the Kabudula Community Hospital pharmacy tech, Dave, along with the other staff there to determine which medications are needed each month. Because Kabudula Community Hospital is a government-owned clinic, the Malawian government provides some medications to the hospital. There are other donors that provide and support the government in supplementing the necessary medication. Despite this, there are some medications needed at the hospital which are not provided due to lack of funds or other barriers. For example, the dental team at Kab was without dental lignocaine (numbing agent) for several months recently, not because they ran out or the government doesn’t supply it, but because the government only buys from certain pharmacies and those pharmacies did not have any. So, because we have no restrictions on where we can buy our medications from, we were able to keep the dental team working hard while they waited for a restock of lignocaine from other sources.

Currently, it is rainy season in Malawi. Rainy season is very important here where a large portion of the population is subsistence farmers, they rely on the rain to nourish their crops so they can harvest them and have food and money for the rest of the year. Rainy season also brings about higher incidence rates of diseases including malaria, cholera and asthma. We always do our best to take into consideration seasonal and cultural factors that may influence which diseases are more prevalent at different times of the year. Right now, cholera and asthma are big concerns for the hospital. So, we focused this month’s delivery on these areas by providing an extra supply of chlorine and salbutamol.

When Dave opened the box, his immediate reaction was “This is the best stuff that you have delivered.” He was so pleased with what we had given the hospital this month because it will really help to address the issues of cholera and asthma that many people are dealing with right now. Each month, Dave helps us brainstorm what the hospital needs to have delivered. He really likes our program because we have no limitations to what products we can provide, we are not bound by any contracts or focused specifically on treating one disease. We fill in the gaps left by other suppliers and focus on the hospital’s most urgent needs, which do vary from month to month. Because we spend a lot of time in and around the hospital working on other projects as well, we are able to assess these needs on a monthly basis and adjust our medication donations accordingly.

Dave left us by saying, “This is complimenting [what we already received from others] but we are moving a great mile [with this delivery]. For example, we haven’t had salbutamol for three to four months and now we have it in good time. By what you have done here, you are becoming a citizen because you are understanding the season and the times and what is needed.”

Although the situation at Kabudula is not as dire as it was back during Kevin’s visit in 2010, we are still proud to be supplying Kabudula Community Hospital with Essential Medications today!

Tropical Cyclone Idai

In the past two weeks, Malawi has been hit with flash floods as a result from Tropical Cyclone Idai. There were two waves of flash floods due to the cyclone leaving many casualties in its’ wake. All WAM employees are safe and uninjured. Some of our Malawian staff has suffered house and property damages that were able to be fixed.

Most of the impact was in the southern region, where houses were washed away, roads and bridges collapsed and lives were lost. The effects of the flooding in Kabudula community were minimal compared to other regions and communities that were devastated. As with any unforeseen circumstance, even minor incidences such as this cause families to suffer because they are already struggling to survive financially, many times depending on one person’s income to support extended family.

Similarly, when someone falls sick in a family and needs surgery, it takes everything the family has just to get them to the hospital for help. Even if they do manage to get there, they often find the public hospital is under-resourced. Private hospitals have more resources but are unaffordable for village residents. This is where our organization comes in, to support the public hospital to be better resourced to handle day to day activities, provide care to hard to reach patients and support when unforeseen events occur.

The cyclone has affected Mozambique and Zimbabwe also, with a death toll climbing close to 1,000. Within our Watsi program at Nkhoma Private Hospital, we often fund Mozambican’s surgeries who seek healthcare they cannot find near their homes.

News updates of Cyclone Idai can be found via all major news outlets.

Getting to Chilobwe Rural Health Center

Our team of three (our two Fellows, Carolyn and Angela and a Research Assistant, Gabriel) visited the last three rural health centers yesterday. The intention was for the entire team to visit all of them together, but due to rainy season, hazardous road conditions and lack of a 4x4 vehicle the plans changed.

The road to Nambuma Health Center.

The road to Nambuma Health Center.

We set off from Lilongwe on the way to Nambuma Rural Health Center. The health centers we have visited are within about 40 KM in all directions from Kabudula Community Hospital. The road to Kabudula from Lilongwe is all paved so it is never an issue for us to get there. All the rural health centers are not off paved roads so to get there we must take dirt roads/paths. Currently it is the middle of the rainy season, so the conditions on these paths are sometimes impassable. Nambuma Health Center is about 40 KM on a dirt path off the main road. At first, it was not a big deal, we were doing fine, but the road kept getting progressively worse. After for what felt like 30 minutes, we did not see any town or health center in sight. We looked at the odometer and we had only gone 5 KM! We were concerned we would get stuck and turned back to find the main road and make a new plan.

We now needed to split up to make all our appointments with the health centers. We went to Kabudula to leave our car and organize rides on motorcycle kabazas (taxis). Angela and I went to Chilobwe Health Center together.  

Tobacco leaves drying in the town we stopped in to refuel.

Tobacco leaves drying in the town we stopped in to refuel.

From Kabudula, Chilobwe is about 20 KM which is SUPPOSED to take about 45 minutes, but the ride there took about 1.5 hours. Angela’s kabaza ran out of fuel about a quarter into the ride, so we had to stop off in a small village to find fuel. The village we stopped in is technically still Kabudula but a suburb or region of it. We just made friends and chatted and waited for her driver to use a borrowed bike, ride to the neighboring suburb and buy fuel.

We were back on the road after 20 minutes and about 10 minutes later my kabaza ran out of fuel! So, Angela’s driver had to go back to the village we just came from to buy more fuel for my driver. We got off and walked a little bit and found some shade while we waited. Finally, we were all back on the road. The conditions were concerning but easily passable on a motorcycle.

On a tour of Chilobwe Health Center

On a tour of Chilobwe Health Center

We finally made it to Chilobwe Health Center and met the staff there. It was a great visit, we were energized by the dedication and hard work of the team. They were so welcoming. We found out that clients who seek treatment come from a radius of up to 25 KM from Chilobwe, and there is only one clinical officer for this area. This clinical officer has worked closely with his community to set up village clinics throughout the catchment area that are ran by Health Surveillance Assistants where people can pick up medication when they are not able to reach the health center. Chilobwe Health Center does not have a maternity ward, so they cannot have deliveries there. Pregnant women from this area have to organize their own transportation to Kabudula to give birth.

We took a tour of the health center but had to cut the meeting short because we could tell the rain was coming soon. We can tell from the temperature change (it gets really hot and humid) faster than we can tell from the sky that the rain is coming. Our drivers could tell too so we booked it back to Kabudula. I bounced around like a Ping-Pong ball on the back of the motorcycle over the uneven dirt paths dodging other bikes, animals and people for 45 minutes. I couldn’t even move that night I was so sore.

All in all, it was a great experience. It highlights the fact that we transportation from rural villages that seek treatment at Kabudula and even the rural health centers is extremely difficult. We had the resources to use kabazas, so it was ‘easy’ for us to get there. This can be almost impossible for many people who live in these areas. And this is just to get to Kabudula. If someone presents with a complicated case, needs to be seen by a medical doctor in Lilongwe and if they are able to afford it, the journey could take an entire day. On top of this, many diseases are worse during the rainy season (mosquitos are more prevalent, which means more malaria, waterborne diseases are also more common) AND almost everyone is subsistence farmers and are waiting for the harvest to come after this season.

We hope our work and experiences can highlight the difficulties many Malawians face in seeking healthcare.

             

Main entrance of Chilobwe Health Center

Main entrance of Chilobwe Health Center

Visit to Malembo Rural Health Center

Rural Health Centers (RHCs) are the most remote location and bottommost tier for healthcare in Malawi. They are often staffed by one Clinical Officer, a nurse or midwife and HSAs (Health Surveillance Assistants). RHCs do not admit patients. RHCs do not have the capacity for surgical intervention and focus mainly on preventative care, primary care and obstetric care (deliveries). The way the healthcare system works here is if there is a complicated case that presents at an RHC, they are referred to a Community Hospital (like Kabudula Community Hospital!). Community Hospitals then refer to District Hospitals who refer to Regional Hospitals.

Malembo Rural Health Center (brick building on left) and cold storage pharmacy (white structure on right).

Malembo Rural Health Center (brick building on left) and cold storage pharmacy (white structure on right).

Kabudula Community Hospital has 8 RHCs that refer to it plus its own community that uses it directly. Its catchment area (area surrounding the hospital that includes RHCs that refer to it and communities where their patients come from) is over 350,000 people.

Ambulance that Malembo uses to transport patients to Kabudula Community Hospital

Ambulance that Malembo uses to transport patients to Kabudula Community Hospital

Yesterday, the GHFs went to Malembo Rural Health Center, one of the 8 that refer to Kabudula Community Hospital. We asked our friends at Kabudula for the directions. We were told it was about 35 KM past Kabudula on the tar road, easy enough right? There are no road signs so once we passed Kabudula we reset the odometer on the dash and started paying attention for a health center. We had to ask for directions 4 times. I wrote the directions down for future use and they are as follows: 28 KM past Kabudula turn right on dirt road (pay attention once the odometer’s at 26KM!), (road might not be passable during rain, and be mindful of the crops on either side) turn right at first t-junction and pass through market place (market place identified by minibuses waiting to load to go to town, and about 3-5 corner shops), turn right at carpenter’s stall (blue stall on right past marketplace) and health center is adjacent to soccer pitch.

We had a wonderful visit with the Clinical Officer and other staff in which we talked about the services they provide and gathered some information for our needs assessment. When we arrived, both of the waiting rooms were overflowing waiting to see the Clinical Officer but the staff was making good use of everyone’s time by conducting community trainings about cholera with the waiting patients (which is an issue more now during rainy season). There was an overall sense of calm and peace at this health center, even though there was as many as 75-100 people waiting to be seen. The hospital staff was so warm and friendly, and the health center was well kept. We really enjoyed our visit with them!

By focusing our interventions at Kabudula Community Hospital AND the catchment area, we are offloading the burden of cases that Kabudula must see and hoping to do our part to lessen the burden all the way up the healthcare chain. We are looking forward to visiting the other Rural Health Centers in the coming weeks!

Back to Nature at Kabudula Community Hospital

Kabudula Hospital staff cleaning up the ceiling collapse hastily to return to business as usual.

Kabudula Hospital staff cleaning up the ceiling collapse hastily to return to business as usual.

Bats have taken over the antenatal department at Kabudula Community Hospital! Apparently they had been nesting between the roof and ceiling of the building which houses the antenatal clinic, ETAT, dental department, and vaccination clinic, but remained unawares for quite some time.

A few weeks ago, the entire roof over the antenatal waiting area collapsed! The feces produced by the bats had built up on the ceiling for so long, that the sheer weight of it caused the entire ceiling to fall through in one unforgettable moment. (Luckily, no patients were affected, as it was almost after hours).

The following day was spent sweeping up the bat feces and carting it off in sack bags to be sold for manure. The staff at Kabudula was working very hastily to clean up the mess and return to business as usual. They are also working to ensure this does not happen again.

The aftermath of the collapse!

The aftermath of the collapse!

Oftentimes, patients in Malawi have many barriers to obtaining healthcare. They don’t have a mode of transportation themselves, or money to take a bus to the healthcare centers. They don’t have resources to afford a hospital stay (family lodging, family and patient food). They are unfamiliar with the healthcare system and don’t know how to properly navigate it, including many not believing that their condition can be treated, or providers in rural areas not having the resources to do so. They are unsure if they will have to be referred to a large hospital, which would mean further transport, longer stay and less familiarity with the system. They are unsure if they will need to purchase medicine, which they may not be able to afford. These are only a few examples on top of the fact that there is only about 1 physician per 1000 citizens in Malawi. The ceiling collapse can be thought of as a metaphor for healthcare access here in Malawi where so many small things compile to prevent a Malawian from obtaining care. We aim to prevent a collapse by reaching patients where they are and addressing these barriers to care.  

Being a Patient at Kabudula Community Hospital

Imagine being a patient at Kabudula Community Hospital…

The entrance to Kabudula Community Hospital

The entrance to Kabudula Community Hospital

When someone falls sick in an African village, the family must find money for transportation to the hospital. They may reach out to other family members or sell a goat or some chickens to find these funds. Once the patient leaves home, he/she may begin by walking several kilometers to a dirt road. If the patient cannot walk, he/she may be carried on the back of a bicycle. Upon reaching the dirt road, another option for transportation may include riding on the back of a motorcycle to the main road. At the main road, the patient may be able to board a minibus for the final part of the journey to the hospital.

A view from Kabudula community.

A view from Kabudula community.

At the hospital, there is usually a long line of patients waiting to be seen, having started lining up since the early morning. These people have all been awake since before sunrise, having had to fetch water and start a fire for morning baths before leaving home. Whenever villagers travel anywhere, such as to the hospital, they bathe meticulously and dress their very best. No one seems to mind waiting for several hours to see the doctor – children play together and families chat in the waiting area as the day proceeds. No one comes to the hospital alone – every patient is escorted by at least one or several family members for support, and mothers generally carry small children on their backs everywhere they go, so it becomes a family event. The extra support is necessary, however, because if the patient is admitted to the hospital for an overnight stay, the accompanying family member is responsible for caring for most of the person’s daily needs. This presents another issue of lodging for family members – it is too far for them to travel back and forth to the hospital each day, and the hospital only has space for patients. So, family members set up camp just outside the main area of the hospital, where you will find many people cooking, washing dishes, washing clothes, and generally camping out for whatever length of time their relative remains a patient in the hospital.

Since individual records are not kept on file at hospitals/clinics, patients carry a “health passport” book with them whenever they go to the hospital. This is a small paper booklet about the same size and shape as a regular passport. Every patient must have one, and this is where the doctor records notes and writes prescriptions.

A ward in Kabudula Community Hospital.

A ward in Kabudula Community Hospital.

Most of the common illnesses presented at Kabudula Community Hospital are readily treatable by the clinicians on staff and the availability of essential medicines from partners like Access Health Africa and World Altering Medicine. However, patients with more serious conditions or complications are referred to hospitals in the capital city, which presents further issues regarding travel and transportation logistics. In addition, these referral hospitals are often over-crowded and under-resourced, making it difficult for everyone to access timely and quality care. We are working together with staff and partners at Kabudula Community Hospital to increase its capacity so that more patients can access the care they need.

Thanks for supporting us to make a difference in this community!

Small but Strong

Working as a Global Health Fellow with Access Health Africa (AHA) and World Altering Medicine (WAM) has allowed me a new perspective of what a non-governmental organization (NGO) can do and provide in the global health field. Compared to aid organizations that most people are familiar with (Unicef, USAID, Partners in Health) AHA and WAM are smaller, but no less capable of providing quality services. I came to this realization recently while in a meeting with these implementing partners who are all working to address the issue of cervical cancer throughout the country.

Malawi has the highest rate of cervical cancer in the world (75 per 100,000). Cervical cancer is entirely preventable but about 63% of women who develop cervical cancer in Malawi die from it. “Screen and Treat” is a proven intervention to diagnose cervical cancer and treat it at an early stage. Currently, the Malawian government has started to roll out a program to provide screen and treat equipment and training to all rural health centers in the country. Many large organizations are helping the government roll out this program country-wide. Until screen and treat becomes widespread allowing cervical cancers to be treated at an earlier stage, there is going to be a great number of women who need advance treatments including surgical intervention (radical hysterectomy).

There is currently a backlog of women in the central region of Malawi (where we mainly operate) that need radical hysterectomy. We were first made aware of this backlog through our partners at Nkhoma Private Hospital, where we run the Watsi program that funds surgeries. AHA and WAM are interested in addressing the issue of cervical cancer, so we set out to explore potential options of maybe helping rid of the backlog. Through the process of making connections with government officials and other organizations who are working to address this issue in Malawi, we were invited to partake in a task-force that consists of many large organizations and the Ministry of Health to gain a better understanding of the work that is already being done here.

The first task-force meeting that we attended, I was completely intimidated by the names and organizations around the table to the point where I didn’t think we even belonged. The information gathered was invaluable and when the time came to introduce ourselves, we simply stated who we were and that we were interested in learning more about the work that was being done already. Immediately after, we were told that there are many organizations (with large budgets and teams) that are working on up-scaling the screen and treat option and there is a great need for implementing partners to help with advanced treatments (like radical hysterectomy).

I couldn’t believe it, this is something we have already developed a proposal to do, help rid the surgical backlog! Here we were at this meeting, the whole time I was thinking, “there is no way that our smaller organizations can possibly fill any gap that is not already covered by large-scale implementing partners,” to be proven completely wrong. Our organizations CAN fill the gap and so much more.

This experience offered me the opportunity to reflect and really think about the strengths of our organizations. In this example, we have expertise and interest in an area that is not covered by other large organizations (access to surgery). We also have taken the time to build partnerships with the communities we serve and focus on providing access to health in conjunction with community members and clinicians there. Being a small organization offers us the opportunity to have more personal relationships with other organizations (such as Watsi) through which we can all work together to provide services because they are able to put a face to the organization and trust us to get the job done. These personal relationships also make our current programs more successful because we have boots on the ground working hand in hand with our Malawian community partners. We may be ‘small’ but our reach is far.

Kabudula Community Hospital.. An Overview

Written by GHF, Angela

A lively community hospital serving a large rural population, Kabudula is the hub for health services in this area. While the hospital does not charge fees, patients often struggle to pay for transportation to reach there, and family members face challenges regarding lodging and food.

We help stock the hospital’s pharmacy with medication when the system experiences shortages, so that patients receive the care the need no matter what.

The location of the proposed new Trauma Room at Kabudula Community Hospital.

The location of the proposed new Trauma Room at Kabudula Community Hospital.

According to a community member interview, the hospital is mostly adequate in the basic services it provides, and most of the departments are equipped and staffed, with just a few areas for improvement. X-ray equipment is available, but there is not radiographer on staff.

Surgical equipment is also available, and it is utilized for C-section deliveries, but not for other surgical procedures. Cervical cancer screening is promoted, but treatment is not available on location. We are conducting a needs assessment of the hospital to better inform future programming and how partners can bring resources together to address these gaps. Improving healthcare at the level of the community hospital is very important in this area because patients who are referred elsewhere may never get helped due to over-crowding at the final referral hospitals or transportation challenges in getting there.

The cold storage pharmacy unit at Kabudula Community Hospital.

The cold storage pharmacy unit at Kabudula Community Hospital.

We are currently in the planning process for building a new emergency department at Kabudula hospital. The current “trauma room” is too small to even fit a bed or stretcher inside!

The need for emergency services has increased with the improvement of the tarmac road through Kabudula, bringing more vehicle accidents. We have chosen a spacious building site just inside the gate of the hospital campus, and we are modeling the design from a recent addition to the Mangochi hospital for the same purpose.

Staff and patients alike look forward to our annual “surgical camps” in conjunction with Access Health Africa, where visiting surgeons come and perform minor surgeries on needy patients while training local clinicians on these procedures. We hope to continue improving the partnership with Kabudula hospital through ongoing programming with the assistance of the Global Health Fellows on the ground year-round. Please continue to support these promising initiatives!